Retrograde approach to pharyngo-esophageal obstruction.

BACKGROUND

The entrance of the esophagus has to be identified for treatment of a pharyngo-esophageal obstruction. If transoropharyngeal identification is unsuccessful, a retrograde approach might be indicated.

METHODS

By way of a mini-laparotomy and gastrotomy, a flexible gastroscope can be passed into the esophagus. In one patient with a Zenker's diverticulum, a guidewire was inserted through the accessory channel of the gastroscope and passed through a stenosis, caused by marked hypertrophy of the cricopharyngeal muscle, into the oral cavity. Thereafter antegrade dilatation and laser assisted myotomy could be performed. In another patient with a membranous obstruction of the esophageal entrance due to radiotherapy, the occlusion was perforated transoropharyngeally and bluntly dilatated guided by the light from the gastroscope.

RESULTS

In both cases the esophageal passage was restored. No complications occurred as a result of the procedures.

CONCLUSIONS

The retrograde approach may be a good alternative when antegrade identification of the esophageal entrance fails.